Pharmacological treatment for psychotic depression
Background Evidence is limited regarding the most effective pharmacological treatment for psychotic depression: combination of an antidepressant plus an antipsychotic, monotherapy with an antidepressant or monotherapy with an antipsychotic. This is an update of a review first published in 2005 and l...
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| Veröffentlicht in: | Cochrane database of systematic reviews 2015-07, Vol.2015 (7), p.CD004044-CD004044 |
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| creator | Wijkstra, Jaap Lijmer, Jeroen Burger, Huibert Cipriani, Andrea Geddes, John Nolen, Willem A Nolen, Willem A |
| description | Background
Evidence is limited regarding the most effective pharmacological treatment for psychotic depression: combination of an antidepressant plus an antipsychotic, monotherapy with an antidepressant or monotherapy with an antipsychotic. This is an update of a review first published in 2005 and last updated in 2009.
Objectives
1. To compare the clinical efficacy of pharmacological treatments for patients with an acute psychotic depression: antidepressant monotherapy, antipsychotic monotherapy and the combination of an antidepressant plus an antipsychotic, compared with each other and/or with placebo.
2. To assess whether differences in response to treatment in the current episode are related to non‐response to prior treatment.
Search methods
A search of the Cochrane Central Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register (CCDANCTR) was carried out (to 12 April 2013). These registers include reports of randomised controlled trials from the following bibliographic databases: EMBASE (1970‐), MEDLINE (1950‐) and PsycINFO (1960‐). Reference lists of all studies and related reviews were screened and key authors contacted.
Selection criteria
All randomised controlled trials (RCTs) that included participants with acute major depression with psychotic features, as well as RCTs consisting of participants with acute major depression with or without psychotic features, that reported separately on the subgroup of participants with psychotic features.
Data collection and analysis
Two review authors independently extracted data and assessed risk of bias in the included studies, according to the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. Data were entered into RevMan 5.1. We used intention‐to‐treat data. For dichotomous efficacy outcomes, the risk ratio (RR) with 95% confidence intervals (CIs) was calculated. For continuously distributed outcomes, it was not possible to extract data from the RCTs. Regarding the primary outcome of harm, only overall dropout rates were available for all studies.
Main results
The search identified 3659 s, but only 12 RCTs with a total of 929 participants could be included in the review. Because of clinical heterogeneity, few meta‐analyses were possible. The main outcome was reduction of severity (response) of depression, not of psychosis.
We found no evidence for the efficacy of monotherapy with an antidepressant or an antipsychotic.
However, evidence suggests |
| doi_str_mv | 10.1002/14651858.CD004044.pub4 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_1732598244</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1732598244</sourcerecordid><originalsourceid>FETCH-LOGICAL-c4184-f22567e89e34955690b75e040292767e054971e28e86687349f92e0823a127ca3</originalsourceid><addsrcrecordid>eNqFkMtOwzAQRS0EoqXwC1WWbFJsx88llKdUCRawtlx3QoOSOtiJUP8eR20RYsNqRrp35s4chKYEzwjG9IowwYniaja_xZhhxmZtv2RHaDwI-aAc_-pH6CzGD4wLoak8RSMqKOUa0zGiL2sbGut87d8rZ-usC2C7BjZdVvqQtXHr1r6rXLaCNkCMld-co5PS1hEu9nWC3u7vXueP-eL54Wl-vcgdI4rlZYoQEpSGgmnOhcZLySHdStMNScCcaUmAKlBCKJlMpaaAFS0sodLZYoIud3vb4D97iJ1pquigru0GfB8NkUV6QlHGklXsrC74GAOUpg1VY8PWEGwGXubAyxx4mYFXGpzuM_plA6ufsQOgZLjZGb6qGrbGebcOKf-fvX9SvgEJAnhX</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1732598244</pqid></control><display><type>article</type><title>Pharmacological treatment for psychotic depression</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Cochrane Library</source><source>Alma/SFX Local Collection</source><creator>Wijkstra, Jaap ; Lijmer, Jeroen ; Burger, Huibert ; Cipriani, Andrea ; Geddes, John ; Nolen, Willem A ; Nolen, Willem A</creator><creatorcontrib>Wijkstra, Jaap ; Lijmer, Jeroen ; Burger, Huibert ; Cipriani, Andrea ; Geddes, John ; Nolen, Willem A ; Nolen, Willem A</creatorcontrib><description>Background
Evidence is limited regarding the most effective pharmacological treatment for psychotic depression: combination of an antidepressant plus an antipsychotic, monotherapy with an antidepressant or monotherapy with an antipsychotic. This is an update of a review first published in 2005 and last updated in 2009.
Objectives
1. To compare the clinical efficacy of pharmacological treatments for patients with an acute psychotic depression: antidepressant monotherapy, antipsychotic monotherapy and the combination of an antidepressant plus an antipsychotic, compared with each other and/or with placebo.
2. To assess whether differences in response to treatment in the current episode are related to non‐response to prior treatment.
Search methods
A search of the Cochrane Central Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register (CCDANCTR) was carried out (to 12 April 2013). These registers include reports of randomised controlled trials from the following bibliographic databases: EMBASE (1970‐), MEDLINE (1950‐) and PsycINFO (1960‐). Reference lists of all studies and related reviews were screened and key authors contacted.
Selection criteria
All randomised controlled trials (RCTs) that included participants with acute major depression with psychotic features, as well as RCTs consisting of participants with acute major depression with or without psychotic features, that reported separately on the subgroup of participants with psychotic features.
Data collection and analysis
Two review authors independently extracted data and assessed risk of bias in the included studies, according to the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. Data were entered into RevMan 5.1. We used intention‐to‐treat data. For dichotomous efficacy outcomes, the risk ratio (RR) with 95% confidence intervals (CIs) was calculated. For continuously distributed outcomes, it was not possible to extract data from the RCTs. Regarding the primary outcome of harm, only overall dropout rates were available for all studies.
Main results
The search identified 3659 s, but only 12 RCTs with a total of 929 participants could be included in the review. Because of clinical heterogeneity, few meta‐analyses were possible. The main outcome was reduction of severity (response) of depression, not of psychosis.
We found no evidence for the efficacy of monotherapy with an antidepressant or an antipsychotic.
However, evidence suggests that the combination of an antidepressant plus an antipsychotic is more effective than antidepressant monotherapy (three RCTs; RR 1.49, 95% CI 1.12 to 1.98, P = 0.006), more effective than antipsychotic monotherapy (four RCTs; RR 1.83, 95% CI 1.40 to 2.38, P = 0.00001) and more effective than placebo (two identical RCTs; RR 1.86, 95% CI 1.23 to 2.82, P = 0.003).
Risk of bias is considerable: there were differences between studies with regard to diagnosis, uncertainties around randomisation and allocation concealment, differences in treatment interventions (pharmacological differences between the various antidepressants and antipsychotics) and different outcome criteria.
Authors' conclusions
Psychotic depression is heavily understudied, limiting confidence in the conclusions drawn. Some evidence indicates that combination therapy with an antidepressant plus an antipsychotic is more effective than either treatment alone or placebo. Evidence is limited for treatment with an antidepressant alone or with an antipsychotic alone.</description><identifier>ISSN: 1465-1858</identifier><identifier>EISSN: 1465-1858</identifier><identifier>EISSN: 1469-493X</identifier><identifier>DOI: 10.1002/14651858.CD004044.pub4</identifier><identifier>PMID: 26225902</identifier><language>eng</language><publisher>Chichester, UK: John Wiley & Sons, Ltd</publisher><subject>Adult ; All pharmacological ; Antidepressive Agents ; Antidepressive Agents - therapeutic use ; Antipsychotic Agents ; Antipsychotic Agents - therapeutic use ; Child & Adolescent ; Child health ; Condition ; Depression ; Depressive disorder ; Depressive Disorder, Major ; Depressive Disorder, Major - drug therapy ; Depressive Disorder, Major - etiology ; Depressive disorders & major depression ; Drug Therapy, Combination ; Drug Therapy, Combination - methods ; Humans ; Intervention ; Medicine General & Introductory Medical Sciences ; Mental health ; Mood disorders ; Older people ; Population ; Psychotic Disorders ; Psychotic Disorders - complications ; Psychotic Disorders - drug therapy ; Randomized Controlled Trials as Topic</subject><ispartof>Cochrane database of systematic reviews, 2015-07, Vol.2015 (7), p.CD004044-CD004044</ispartof><rights>Copyright © 2015 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4184-f22567e89e34955690b75e040292767e054971e28e86687349f92e0823a127ca3</citedby><cites>FETCH-LOGICAL-c4184-f22567e89e34955690b75e040292767e054971e28e86687349f92e0823a127ca3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26225902$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Wijkstra, Jaap</creatorcontrib><creatorcontrib>Lijmer, Jeroen</creatorcontrib><creatorcontrib>Burger, Huibert</creatorcontrib><creatorcontrib>Cipriani, Andrea</creatorcontrib><creatorcontrib>Geddes, John</creatorcontrib><creatorcontrib>Nolen, Willem A</creatorcontrib><creatorcontrib>Nolen, Willem A</creatorcontrib><title>Pharmacological treatment for psychotic depression</title><title>Cochrane database of systematic reviews</title><addtitle>Cochrane Database Syst Rev</addtitle><description>Background
Evidence is limited regarding the most effective pharmacological treatment for psychotic depression: combination of an antidepressant plus an antipsychotic, monotherapy with an antidepressant or monotherapy with an antipsychotic. This is an update of a review first published in 2005 and last updated in 2009.
Objectives
1. To compare the clinical efficacy of pharmacological treatments for patients with an acute psychotic depression: antidepressant monotherapy, antipsychotic monotherapy and the combination of an antidepressant plus an antipsychotic, compared with each other and/or with placebo.
2. To assess whether differences in response to treatment in the current episode are related to non‐response to prior treatment.
Search methods
A search of the Cochrane Central Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register (CCDANCTR) was carried out (to 12 April 2013). These registers include reports of randomised controlled trials from the following bibliographic databases: EMBASE (1970‐), MEDLINE (1950‐) and PsycINFO (1960‐). Reference lists of all studies and related reviews were screened and key authors contacted.
Selection criteria
All randomised controlled trials (RCTs) that included participants with acute major depression with psychotic features, as well as RCTs consisting of participants with acute major depression with or without psychotic features, that reported separately on the subgroup of participants with psychotic features.
Data collection and analysis
Two review authors independently extracted data and assessed risk of bias in the included studies, according to the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. Data were entered into RevMan 5.1. We used intention‐to‐treat data. For dichotomous efficacy outcomes, the risk ratio (RR) with 95% confidence intervals (CIs) was calculated. For continuously distributed outcomes, it was not possible to extract data from the RCTs. Regarding the primary outcome of harm, only overall dropout rates were available for all studies.
Main results
The search identified 3659 s, but only 12 RCTs with a total of 929 participants could be included in the review. Because of clinical heterogeneity, few meta‐analyses were possible. The main outcome was reduction of severity (response) of depression, not of psychosis.
We found no evidence for the efficacy of monotherapy with an antidepressant or an antipsychotic.
However, evidence suggests that the combination of an antidepressant plus an antipsychotic is more effective than antidepressant monotherapy (three RCTs; RR 1.49, 95% CI 1.12 to 1.98, P = 0.006), more effective than antipsychotic monotherapy (four RCTs; RR 1.83, 95% CI 1.40 to 2.38, P = 0.00001) and more effective than placebo (two identical RCTs; RR 1.86, 95% CI 1.23 to 2.82, P = 0.003).
Risk of bias is considerable: there were differences between studies with regard to diagnosis, uncertainties around randomisation and allocation concealment, differences in treatment interventions (pharmacological differences between the various antidepressants and antipsychotics) and different outcome criteria.
Authors' conclusions
Psychotic depression is heavily understudied, limiting confidence in the conclusions drawn. Some evidence indicates that combination therapy with an antidepressant plus an antipsychotic is more effective than either treatment alone or placebo. Evidence is limited for treatment with an antidepressant alone or with an antipsychotic alone.</description><subject>Adult</subject><subject>All pharmacological</subject><subject>Antidepressive Agents</subject><subject>Antidepressive Agents - therapeutic use</subject><subject>Antipsychotic Agents</subject><subject>Antipsychotic Agents - therapeutic use</subject><subject>Child & Adolescent</subject><subject>Child health</subject><subject>Condition</subject><subject>Depression</subject><subject>Depressive disorder</subject><subject>Depressive Disorder, Major</subject><subject>Depressive Disorder, Major - drug therapy</subject><subject>Depressive Disorder, Major - etiology</subject><subject>Depressive disorders & major depression</subject><subject>Drug Therapy, Combination</subject><subject>Drug Therapy, Combination - methods</subject><subject>Humans</subject><subject>Intervention</subject><subject>Medicine General & Introductory Medical Sciences</subject><subject>Mental health</subject><subject>Mood disorders</subject><subject>Older people</subject><subject>Population</subject><subject>Psychotic Disorders</subject><subject>Psychotic Disorders - complications</subject><subject>Psychotic Disorders - drug therapy</subject><subject>Randomized Controlled Trials as Topic</subject><issn>1465-1858</issn><issn>1465-1858</issn><issn>1469-493X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>RWY</sourceid><sourceid>EIF</sourceid><recordid>eNqFkMtOwzAQRS0EoqXwC1WWbFJsx88llKdUCRawtlx3QoOSOtiJUP8eR20RYsNqRrp35s4chKYEzwjG9IowwYniaja_xZhhxmZtv2RHaDwI-aAc_-pH6CzGD4wLoak8RSMqKOUa0zGiL2sbGut87d8rZ-usC2C7BjZdVvqQtXHr1r6rXLaCNkCMld-co5PS1hEu9nWC3u7vXueP-eL54Wl-vcgdI4rlZYoQEpSGgmnOhcZLySHdStMNScCcaUmAKlBCKJlMpaaAFS0sodLZYoIud3vb4D97iJ1pquigru0GfB8NkUV6QlHGklXsrC74GAOUpg1VY8PWEGwGXubAyxx4mYFXGpzuM_plA6ufsQOgZLjZGb6qGrbGebcOKf-fvX9SvgEJAnhX</recordid><startdate>20150730</startdate><enddate>20150730</enddate><creator>Wijkstra, Jaap</creator><creator>Lijmer, Jeroen</creator><creator>Burger, Huibert</creator><creator>Cipriani, Andrea</creator><creator>Geddes, John</creator><creator>Nolen, Willem A</creator><creator>Nolen, Willem A</creator><general>John Wiley & Sons, Ltd</general><scope>7PX</scope><scope>RWY</scope><scope>ZYTZH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20150730</creationdate><title>Pharmacological treatment for psychotic depression</title><author>Wijkstra, Jaap ; Lijmer, Jeroen ; Burger, Huibert ; Cipriani, Andrea ; Geddes, John ; Nolen, Willem A ; Nolen, Willem A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4184-f22567e89e34955690b75e040292767e054971e28e86687349f92e0823a127ca3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Adult</topic><topic>All pharmacological</topic><topic>Antidepressive Agents</topic><topic>Antidepressive Agents - therapeutic use</topic><topic>Antipsychotic Agents</topic><topic>Antipsychotic Agents - therapeutic use</topic><topic>Child & Adolescent</topic><topic>Child health</topic><topic>Condition</topic><topic>Depression</topic><topic>Depressive disorder</topic><topic>Depressive Disorder, Major</topic><topic>Depressive Disorder, Major - drug therapy</topic><topic>Depressive Disorder, Major - etiology</topic><topic>Depressive disorders & major depression</topic><topic>Drug Therapy, Combination</topic><topic>Drug Therapy, Combination - methods</topic><topic>Humans</topic><topic>Intervention</topic><topic>Medicine General & Introductory Medical Sciences</topic><topic>Mental health</topic><topic>Mood disorders</topic><topic>Older people</topic><topic>Population</topic><topic>Psychotic Disorders</topic><topic>Psychotic Disorders - complications</topic><topic>Psychotic Disorders - drug therapy</topic><topic>Randomized Controlled Trials as Topic</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Wijkstra, Jaap</creatorcontrib><creatorcontrib>Lijmer, Jeroen</creatorcontrib><creatorcontrib>Burger, Huibert</creatorcontrib><creatorcontrib>Cipriani, Andrea</creatorcontrib><creatorcontrib>Geddes, John</creatorcontrib><creatorcontrib>Nolen, Willem A</creatorcontrib><creatorcontrib>Nolen, Willem A</creatorcontrib><collection>Wiley-Blackwell Cochrane Library</collection><collection>Cochrane Library</collection><collection>Cochrane Library (Open Aceess)</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Cochrane database of systematic reviews</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Wijkstra, Jaap</au><au>Lijmer, Jeroen</au><au>Burger, Huibert</au><au>Cipriani, Andrea</au><au>Geddes, John</au><au>Nolen, Willem A</au><au>Nolen, Willem A</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Pharmacological treatment for psychotic depression</atitle><jtitle>Cochrane database of systematic reviews</jtitle><addtitle>Cochrane Database Syst Rev</addtitle><date>2015-07-30</date><risdate>2015</risdate><volume>2015</volume><issue>7</issue><spage>CD004044</spage><epage>CD004044</epage><pages>CD004044-CD004044</pages><issn>1465-1858</issn><eissn>1465-1858</eissn><eissn>1469-493X</eissn><abstract>Background
Evidence is limited regarding the most effective pharmacological treatment for psychotic depression: combination of an antidepressant plus an antipsychotic, monotherapy with an antidepressant or monotherapy with an antipsychotic. This is an update of a review first published in 2005 and last updated in 2009.
Objectives
1. To compare the clinical efficacy of pharmacological treatments for patients with an acute psychotic depression: antidepressant monotherapy, antipsychotic monotherapy and the combination of an antidepressant plus an antipsychotic, compared with each other and/or with placebo.
2. To assess whether differences in response to treatment in the current episode are related to non‐response to prior treatment.
Search methods
A search of the Cochrane Central Register of Controlled Trials and the Cochrane Depression, Anxiety and Neurosis Group Register (CCDANCTR) was carried out (to 12 April 2013). These registers include reports of randomised controlled trials from the following bibliographic databases: EMBASE (1970‐), MEDLINE (1950‐) and PsycINFO (1960‐). Reference lists of all studies and related reviews were screened and key authors contacted.
Selection criteria
All randomised controlled trials (RCTs) that included participants with acute major depression with psychotic features, as well as RCTs consisting of participants with acute major depression with or without psychotic features, that reported separately on the subgroup of participants with psychotic features.
Data collection and analysis
Two review authors independently extracted data and assessed risk of bias in the included studies, according to the criteria of the Cochrane Handbook for Systematic Reviews of Interventions. Data were entered into RevMan 5.1. We used intention‐to‐treat data. For dichotomous efficacy outcomes, the risk ratio (RR) with 95% confidence intervals (CIs) was calculated. For continuously distributed outcomes, it was not possible to extract data from the RCTs. Regarding the primary outcome of harm, only overall dropout rates were available for all studies.
Main results
The search identified 3659 s, but only 12 RCTs with a total of 929 participants could be included in the review. Because of clinical heterogeneity, few meta‐analyses were possible. The main outcome was reduction of severity (response) of depression, not of psychosis.
We found no evidence for the efficacy of monotherapy with an antidepressant or an antipsychotic.
However, evidence suggests that the combination of an antidepressant plus an antipsychotic is more effective than antidepressant monotherapy (three RCTs; RR 1.49, 95% CI 1.12 to 1.98, P = 0.006), more effective than antipsychotic monotherapy (four RCTs; RR 1.83, 95% CI 1.40 to 2.38, P = 0.00001) and more effective than placebo (two identical RCTs; RR 1.86, 95% CI 1.23 to 2.82, P = 0.003).
Risk of bias is considerable: there were differences between studies with regard to diagnosis, uncertainties around randomisation and allocation concealment, differences in treatment interventions (pharmacological differences between the various antidepressants and antipsychotics) and different outcome criteria.
Authors' conclusions
Psychotic depression is heavily understudied, limiting confidence in the conclusions drawn. Some evidence indicates that combination therapy with an antidepressant plus an antipsychotic is more effective than either treatment alone or placebo. Evidence is limited for treatment with an antidepressant alone or with an antipsychotic alone.</abstract><cop>Chichester, UK</cop><pub>John Wiley & Sons, Ltd</pub><pmid>26225902</pmid><doi>10.1002/14651858.CD004044.pub4</doi><oa>free_for_read</oa></addata></record> |
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| ispartof | Cochrane database of systematic reviews, 2015-07, Vol.2015 (7), p.CD004044-CD004044 |
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| source | MEDLINE; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Cochrane Library; Alma/SFX Local Collection |
| subjects | Adult All pharmacological Antidepressive Agents Antidepressive Agents - therapeutic use Antipsychotic Agents Antipsychotic Agents - therapeutic use Child & Adolescent Child health Condition Depression Depressive disorder Depressive Disorder, Major Depressive Disorder, Major - drug therapy Depressive Disorder, Major - etiology Depressive disorders & major depression Drug Therapy, Combination Drug Therapy, Combination - methods Humans Intervention Medicine General & Introductory Medical Sciences Mental health Mood disorders Older people Population Psychotic Disorders Psychotic Disorders - complications Psychotic Disorders - drug therapy Randomized Controlled Trials as Topic |
| title | Pharmacological treatment for psychotic depression |
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